The effort to form a primary care physician union is under arbitration with the National Labor Relations Board, and a decision is not expected for months. We talk with both sides.
In recent years, there has been a spike in physician unionization including seven residency programs voting to unionize in 2023, according to a research article published by the Journal of Surgical Education. The threat of physician strikes has grown significantly, according to the article.
Primary care physicians at Mass General Brigham (MGB) say they want to form a union because working conditions have become unsustainable, and the health system is resisting the unionization effort.
Primary care physicians (PCPs) employed by MGB filed their intent to unionize with the National Labor Relations Board (NLRB) in November. The PCPs are seeking to join the Doctors Council, the country’s oldest and largest union of attending physicians.
Working conditions at MGB's primary care practices are the main motivating factor for the health system's PCPs seeking to form a union, says Andrew Warren, MD, a PCP who is organizing his colleagues at Brigham Primary Physicians at Brigham and Women's Faulkner Hospital.
"We have gotten into a situation where the workload and the expectations are ever-expanding," Warren says. "The amount of support we are getting is never sufficient. This situation is hard on physicians and hard on the staff. We have gotten to a point where it is unsustainable."
Inadequate staffing is placing an unbearable load on PCPs, Warren explains, and it is affecting recruitment and retention.
"The workload is increasing, and at the same time we are losing staff, including doctors, nurses, medical assistants, and front-desk staff," Warren says. "People are feeling overworked, and when they are not compensated well or appreciated, we lose a lot of them, especially staff who are most experienced. Then we have trouble hiring new staff, and that adds to the problem."
The leadership of the health system is aware of the situation, but according to Warren, nothing ever seems to happen.
"We got to the point where unionizing was the best option," Warren says.
The benefits of unionizing include being able to work with the administration to find a way to establish a realistic workload, Warren explains.
"At least for me, it is about whether I am going to burn out," Warren says. "If something does not drastically change, I can't see myself doing this job for more than a couple more years because I cannot keep up this pace."
MGB and its PCPs have entered arbitration with the NLRB.
"We have gone to arbitration and are now waiting on the NLRB, which has a six-month backlog," Warren says.
As a general proposition, MGB is opposed to having doctors unionize, according to Jessica Pastore, senior director of public affairs at the health system.
"We feel that it is important to work directly with our physicians and other clinicians without an external third party," Pastore says.
MGB is resisting the formation of a PCP union because the doctors are facing challenges that are not entirely within the health system's control and a union poses an unacceptable risk, an MGB spokesperson says.
"We know that PCPs across the commonwealth are facing unprecedented volume and stress as a result of a confluence of factors that are not unique to our organization," the spokesperson says. "We share the common goal of offering world-class, comprehensive care for our patients and believe we can achieve this best by working together in direct partnership, rather than through representatives in a process that can lead to conflict and potentially risk the continuity of patient care."
Profits over patients?
MGB is putting profits over patients, according to Warren.
"MGB is prioritizing profit over patient care. I don't think there is any argument to that fact," Warren says. "They have made it clear that they are going to put money into things where they get a return on investment, and primary care has never been one of those things."
With the way the healthcare system works, a primary care office is rarely going to be a health system’s money maker, Warren explains.
"In the best-case scenario, you might break even, but because of the logistics and staff, primary care does not make money," Warren says. "For example, we do not do lucrative procedures like the surgeons do."
However, Pastore says MGB is not fixated on profits.
"We are a nonprofit, so any so-called profit goes back into our mission," Pastore says. "For example, we invest hundreds of millions of dollars to improve health in our communities. It is important for us to be able to sustain this mission."
According to Pastore, MGB recently committed a $65 million investment in housing, mental health, economic mobility, and food insecurity, and it invested $25 million in the Massachusetts Community Health & Healthy Aging Funds.
"These grant opportunities are designed to reduce housing inequities, which is a core part of our mission in communities across the commonwealth," Pastore says. "We are also addressing other social determinants of health."
Photo: Dr. Andrew Warren, center, walks an informational picket line outside Brigham and Women’s Hospital in Boston on Dec. 13.
Christopher Cheney is the CMO editor at HealthLeaders.
KEY TAKEAWAYS
A primary care physician involved in organizing the union effort says working conditions are a primary driver of the unionization effort.
Workforce shortages are contributing to heavy workloads, the doctor says.
The doctors claim Mass General Brigham is putting profits over patients, but the health system says any profits are plowed back into the organization's nonprofit mission.